Back Clear search

The Drug-Induced Respiratory Disease Website and App

Mesalazine-Mesalamine-5-aminosalicylic acid (5ASA)

Specialities: Gastroenterology · Pulmonary medicine

Mesalazine, mesalasine or 5-aminosalicylate. Several patterns or respiratory involvement caused by this drug can also be observed in the course of untreated inflammatory bowel disease UC and CD. Causality in cases with exposure to mesalazine and anti-TNF agents can be difficult to disentangle from IBD-related ILD (PMID: 23983443). Drug-induced involvement in IBD is against the specific respiratory and cardiovasculare manifestations of the IBD UC and CD (PMID: 8502168, 22958334, 42719527).

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
I.b

Pneumonitis (interstitial lung disease/ILD)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
I.e

Acute eosinophilic pneumonia (AEP)
I.m

ILD with a granulomatous component
I.z

An area or areas of consolidation

II - Pulmonary edema - Acute lung injury - ARDS

II.d

Pulmonary edema, cardiogenic

IV - Airway involvement

IV.c

Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)
IV.j

Bronchiolitis (a clinical-imaging pattern suggestive of)
IV.k

Bronchiectasis
IV.ad

Large airway inflammation - Tracheitis (w/wo tissue eosinophilia)

V - Pleural and/or pericardial involvement

V.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)
V.b

Eosinophilic pleural effusion
V.m

Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.bb

Tracheitis including eosinophilic tracheal inflammation

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction
X.d

Lupus - Lupus syndrome (see also Vd)

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XII - Cardiovascular involvement / toxicity

XII.a

Left or biventricular dysfunction/failure
XII.c

Pericardial effusion (w/wo tamponade)
XII.d

Myocarditis (can be fulminant)
XII.g

Coronary artery disease (acute) - Myocardial ischemia/infarction
XII.h

Eosinophilic myocarditis
XII.n

Cardiovascular collapse - Cardiogenic shock - Hypotension
XII.q

Pericarditis (see also under XIIc)
XII.bf

Myopericarditis (see under XIIc/d/g)

XV - Pathology

XV.a

Path: NSIP-cellular pattern (see also Ia, Ib)
XV.b

Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)
XV.c

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)
XV.e

Path: ILD with a granulomatous component (see also Im)
XV.z

Path: Obliterative (constrictive) bronchiolitis (see also IVc, IVn)

XVI - Imaging

XVI.b

Imaging: Ground-glass opacities (GGO) / shadowing
XVI.k

Imaging: An area or areas of consolidation
XVI.ay

Imaging: Asymmetrical, predominantly unilateral involvement

XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.a

BAL: An excess proportion of lymphocytes
XIX.c

BAL: An excess proportion of eosinophils